Provider Demographics
NPI:1033274576
Name:MONTEIRO&SCOTT FAMILY DENTAL PRACTICE,LLC
Entity Type:Organization
Organization Name:MONTEIRO&SCOTT FAMILY DENTAL PRACTICE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-885-7331
Mailing Address - Street 1:1622 SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2834
Mailing Address - Country:US
Mailing Address - Phone:215-885-7331
Mailing Address - Fax:215-572-8571
Practice Address - Street 1:1622 SPRING AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2834
Practice Address - Country:US
Practice Address - Phone:215-885-7331
Practice Address - Fax:215-572-8571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO27056L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty